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International Journal of Clinical Pharmacy

, Volume 35, Issue 5, pp 847–853 | Cite as

Drug related problems and pharmacist interventions in a geriatric unit employing electronic prescribing

  • Mélina Raimbault-ChupinEmail author
  • Laurence Spiesser-Robelet
  • Véronique Guir
  • Cédric Annweiler
  • Olivier Beauchet
  • Marie-Anne Clerc
  • Frédéric Moal
Research Article

Abstract

Background Computerised physician order entry (CPOE) and the integration of a pharmacist in clinical wards have been shown to prevent drug related problems (DRPs). Objectives The primary objective was to make an inventory of the DRPs and resident pharmacist on-ward interventions (PIs) identified in a geriatric acute care unit using CPOE system. The secondary objective was to evaluate the physicians’ acceptance of the proposed interventions. Setting A 26-bed geriatric ward of a 1,300-bed teaching hospital. Method A 6-month descriptive study with prescription analysis and recommendations to physicians by a resident pharmacist during five half days a week. Main outcome measures Patients’ characteristics, number of prescribed drugs per patient, nature and frequency of DRPs and PIs, physicians’ acceptance and drugs questioned. Results Resident pharmacist reviewed 311 patients and identified 241 DRPs. One hundred and fifty-two patients (49 %) had at least one DRP (mean ± SD age 87 ± 6 years, mean ± SD number of prescribed drugs 10.7 ± 3.4). Most frequent DRPs were: untreated indication (n = 58, 24.1 %), dose too high (n = 46, 19.1 %), improper administration (n = 31, 12.9 %) and drug interactions (n = 23, 9.5 %). The rate of physicians’ acceptance was 90.0 % (7.5 % refusals, 2.5 % not assessable). DRPs related to CPOE system misuse (n = 35, 14.5 %) appeared as a worrying phenomenon (e.g., errors in selecting dosage or unit, or duplication of therapy). Conclusion A resident pharmacist detected various DRPs. Most PIs were accepted. DRPs related to the misuse of the CPOE system appeared potentially dangerous and need particular attention by healthcare professionals. The description of the DRPs is an essential step for implementation of targeted clinical pharmacy services in order to optimize pharmacists’ job time.

Keywords

Aged Clinical pharmacist CPOE Drug therapy France Geriatrics Medication error Pharmacists’ interventions 

Notes

Funding

None.

Conflicts of interest

None.

References

  1. 1.
    Kaur S, Mitchell G, Vitetta L, Roberts MS. Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging. 2009;26(12):1013–28.PubMedCrossRefGoogle Scholar
  2. 2.
    Merle L, Laroche ML, Dantoine T, Charmes JP. Predicting and preventing adverse drug reactions in the very old. Drugs Aging. 2005;22(5):375–92.PubMedCrossRefGoogle Scholar
  3. 3.
    Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24(2):46–54.PubMedCrossRefGoogle Scholar
  4. 4.
    Cecile M, Seux V, Pauly V, Tassy S, Reynaud-Levy O, Dalco O, et al. Adverse drug events in hospitalized elderly patients in a geriatric medicine unit: study of prevalence and risk factors. Rev Med Interne. 2009;30(5):393–400.PubMedCrossRefGoogle Scholar
  5. 5.
    Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001;49(2):200–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Hanlon JT, Lindblad CI, Gray SL. Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults? Am J Geriatr Pharmacother. 2004;2(1):3–13.PubMedCrossRefGoogle Scholar
  7. 7.
    Owens NJ, Sherburne NJ, Silliman RA, Fretwell MD. The Senior Care Study. The optimal use of medications in acutely ill older patients. J Am Geriatr Soc. 1990;38(10):1082–7.PubMedGoogle Scholar
  8. 8.
    Spinewine A, Swine C, Dhillon S, Lambert P, Nachega JB, Wilmotte L, et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc. 2007;55(5):658–65.PubMedCrossRefGoogle Scholar
  9. 9.
    Brown BK, Earnhart J. Pharmacists and their effectiveness in ensuring the appropriateness of the chronic medication regimens of geriatric inpatients. Consult Pharm. 2004;19(5):432–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Holland R, Desborough J, Goodyer L, Hall S, Wright D, Loke YK. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol. 2008;65(3):303–16.PubMedCrossRefGoogle Scholar
  11. 11.
    Brookes K, Scott MG, McConnell JB. The benefits of a hospital based community services liaison pharmacist. Pharm World Sci. 2000;22(2):33–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Boyko WL Jr, Yurkowski PJ, Ivey MF, Armitstead JA, Roberts BL. Pharmacist influence on economic and morbidity outcomes in a tertiary care teaching hospital. Am J Health Syst Pharm. 1997;54(14):1591–5.PubMedGoogle Scholar
  13. 13.
    Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894–900.PubMedCrossRefGoogle Scholar
  14. 14.
    Lopez Cabezas C, Falces Salvador C, Cubi Quadrada D, Arnau Bartes A, Ylla Bore M, Muro Perea N, et al. Randomized clinical trial of a postdischarge pharmaceutical care program vs regular follow-up in patients with heart failure. Farm Hosp. 2006;30(6):328–42.PubMedCrossRefGoogle Scholar
  15. 15.
    Badger N, Mullis S, Butler K, Tucker D. Pharmacist’s intervention for older hospitalized patients. Am J Health Syst Pharm. 2007;64(17):1794–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002;54(6):657–64.PubMedCrossRefGoogle Scholar
  17. 17.
    Crotty M, Rowett D, Spurling L, Giles LC, Phillips PA. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother. 2004;2(4):257–64.PubMedCrossRefGoogle Scholar
  18. 18.
    Surugue J, Vulto A. Workforce of EU Hospitals and Pharmacy Services: a direct patient safety issue. Eur J Hosp Pharm Prac. 2006;12:31–34.Google Scholar
  19. 19.
    Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration. Am J Health Syst Pharm. 2011;69(9):768–85.CrossRefGoogle Scholar
  20. 20.
    Legifrance. Arrêté du 9 août 1991 portant application de l’article R. 5203 du code de la santé publique dans les établissements mentionnés à l’article L. 577 du même code. [cited 2013 Feb 6]. Available from: http://legifrance.gouv.fr/affichTexte.do;jsessionid=2C444C1ADDCD2EDBD05FDB0781583379.tpdjo06v_2?cidTexte=JORFTEXT000000690713&dateTexte=19990331.
  21. 21.
    Legifrance. Arrêté du 6 avril 2011 relatif au management de la qualité de la prise en charge médicamenteuse et aux médicaments dans les établissements de santé. [cited 2013 Feb 6]. Available from: http://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000023865866&dateTexte=&categorieLien=id.
  22. 22.
    Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293(10):1197–203.PubMedCrossRefGoogle Scholar
  23. 23.
    van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother. 2004;38(5):859–67.PubMedCrossRefGoogle Scholar
  24. 24.
    The Society of Hospital Pharmacists of Australia Committee of Speciality Practice in Clinical Pharmacy. Practice Standards & Definitions. Melbourne: The Society of Hospital Pharmacists of Australia; 1996. Standards of Practice for Clinical Pharmacy.Google Scholar
  25. 25.
    Allenet B, Bedouch P, Rose FX, Escofier L, Roubille R, Charpiat B, et al. Validation of an instrument for the documentation of clinical pharmacists’ interventions. Pharm World Sci. 2006;28(4):181–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Bedouch P, Charpiat B, Conort O, Rose FX, Escofier L, Juste M, et al. Assessment of clinical pharmacists’ interventions in French hospitals: results of a multicenter study. Ann Pharmacother. 2008;42(7):1095–103.PubMedCrossRefGoogle Scholar
  27. 27.
    Arques-Armoiry E, Cabelguenne D, Stamm C, Janoly-Dumenil A, Grosset-Grange I, Vantard N, et al. Most frequent drug-related events detected by pharmacists during prescription analysis in a university hospital. Rev Med Interne. 2010;31(12):804–11.PubMedCrossRefGoogle Scholar
  28. 28.
    Bouchand F, Thomas A, Zerhouni L, Dauphin A, Conort O. Interventions pharmaceutiques avant et après informatisation de la prescription dans un service de médecine interne. Press Méd. 2007;36(3):410–8.CrossRefGoogle Scholar
  29. 29.
    Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C. Implementation of ward-based clinical pharmacy services in Belgium–description of the impact on a geriatric unit. Ann Pharmacother. 2006;40(4):720–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Lang PO, Hasso Y, Drame M, Vogt-Ferrier N, Prudent M, Gold G, et al. Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities. Age Ageing. 2010;39(3):373–81.PubMedCrossRefGoogle Scholar
  31. 31.
    Charpiat B, Bedouch P, Conort O, Rose FX, Juste M, Roubille R, et al. Opportunities for medication errors and pharmacist’s interventions in the context of computerized prescription order entry: a review of data published by French hospital pharmacists. Ann Pharm Fr. 2012;70(2):62–74.PubMedCrossRefGoogle Scholar
  32. 32.
    Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006;13(5):547–56.PubMedCrossRefGoogle Scholar
  33. 33.
    Barber ND, Batty R, Ridout DA. Predicting the rate of physician-accepted interventions by hospital pharmacists in the United Kingdom. Am J Health Syst Pharm. 1997;54(4):397–405.PubMedGoogle Scholar
  34. 34.
    Bedouch P, Tessier A, Baudrant M, Labarere J, Foroni L, Calop J, et al. Computerized physician order entry system combined with on-ward pharmacist: analysis of pharmacists’ interventions. J Eval Clin Pract 2012;18(4):911–918.Google Scholar
  35. 35.
    Bedouch P, Allenet B, Labarere J, Brudieu E, Chen C, Chevrot D, et al. Diffusion des opinions pharmaceutiques dans le cadre d’une activité de pharmacie clinique en unité de soins. Thérapie. 2005;60(5):515–22.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Mélina Raimbault-Chupin
    • 1
    Email author
  • Laurence Spiesser-Robelet
    • 1
  • Véronique Guir
    • 2
  • Cédric Annweiler
    • 2
    • 3
  • Olivier Beauchet
    • 2
    • 3
  • Marie-Anne Clerc
    • 1
  • Frédéric Moal
    • 1
  1. 1.Department of PharmacyAngers University HospitalAngers cedex 09France
  2. 2.Division of Geriatric Medicine, Department of NeuroscienceAngers University HospitalAngers cedex 09France
  3. 3.UPRES EA 4638University of AngersAngersFrance

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